AI Article Synopsis

  • The bilobed flap is a common surgical technique used for reconstructing nasal defects, especially in the lower third of the nose, which is challenging due to its complex structure and skin properties.
  • A review of 148 cases revealed that complications occurred in 52% of procedures, with issues like asymmetry and wound dehiscence being frequent, particularly for defects in the lower part of the nose.
  • Although the bilobed flap offers good cosmetic results, careful patient selection and surgical approach are essential to minimize complications and improve aesthetic outcomes.

Article Abstract

Purpose: Reconstruction of nasal defects, particularly in the lower third of the nose, presents significant challenges due to the area's complex 3-dimensional structure and thicker, more sebaceous skin. The bilobed flap, a double transposition flap, has been a popular method for addressing these nasal defects.

Methods: This retrospective review examines a single surgeon's experience with bilobed flaps for nasal reconstruction over the last 15 years. Demographics, defect characteristics, intraoperative details, postoperative complications, and revisionary procedures were documented, and univariate and multivariate logistic regression analyses were used to assess complication rate associations.

Results: In all, 148 bilobed reconstructions were analyzed, with a mean patient age of 62.6 years and 46.0% male prevalence. The most common indication for the procedure was basal cell carcinoma following Mohs surgery, with the majority of the defects located on the lower third of the nose. The average defect size was 1.11 cm². Complications occurred in 52.0% of cases, including pincushioning, scar thickening, asymmetry, alar stenosis, and wound dehiscence. Reoperations and additional treatments such as dermabrasion, steroid injections, and laser therapy were frequently necessary to address these issues. Logistic regression analysis demonstrated significantly more postoperative complications when the defect was located on the lower third of the nose when compared with the upper two-thirds.

Conclusions: While the bilobed flap can provide adequate skin coverage with perfect color match, it is associated with notable complications that impact esthetic outcomes. Proper patient selection and surgical technique are crucial for optimizing results.

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Source
http://dx.doi.org/10.1097/SCS.0000000000010466DOI Listing

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